The Sunday Mail
Roselyne Sachiti
Assistant Editor
A HEAP of uncollected refuse stands imposingly at the Copacabana bus terminus in Harare’s central business district (CBD).
The day is Thursday April 20, and a group of men scavenge for plastic containers, which they pack into large sacks.
Adjacent to the refuse, water flowing from a public toilet emits a strong stench of human waste. Commuters and anyone else passing by have no choice but breathe the foul air. Just a few steps away, fruit and vegetable vendors operate from a stall near Dubai Mall. Several other vendors line up as they sell vegetables, roasted maize, cooked round and ground nuts and other food items.
A tout, Max Mudonhi (30), buys an apple, which he immediately eats.
“I don’t wash fruits. My stomach is used to eating them unwashed. In the village, we picked up fruits from the ground, ate and never got sick,” he bragged.
Added Mudonhi: “I eat these daily and do not get sick. God will protect me. Cholera is not yet in Harare. Is it here?”
According to the World Health Organisation (WHO), cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It is an extremely virulent disease that can cause severe acute watery diarrhoea.
Cases increase
Despite the Ministry of Health and Child Care (MOHCC) reporting that by April 20, 2023, Zimbabwe recorded five new suspected cholera cases and three laboratory confirmed results, Mudonhi seems unmoved.
He is somewhat convinced that he is immune to the infectious disease and it is affecting other people far from the capital. However, the MOHCC further warned that the latest suspected cases were reported in Nyanga (3), Mutasa (1) and Mwenezi (1).
Six cases resulted in hospitalisation at the Beitbridge District Hospital CTC (1) in Matabeleland South province; Mutare City (3) and Nyanga district (1), in Manicaland province; and Mwenezi district (1) in Masvingo province, as of April 20, 2023. A cumulative total of 484 suspected cholera cases, two laboratory confirmed deaths, seven suspected cholera deaths and 105 laboratory confirmed cases were reported. While Harare has only recorded one suspected cholera case and recovery, what is happening at Copacabana, and in many other parts of the city is worrying. The mounds of refuse in Harare are of major public health concern and put residents at high risk of contracting cholera if the situation persists. Prevention of cholera should be a priority.
Waste management
Speaking to The Sunday Mail, Community Working Group on Health (CWGH) executive director Itai Rusike said, in order to address the public health issues surrounding cholera outbreaks, there is need to organise a massive clean-up of public markets and stopping vending of food in undesignated areas.
“Waste management should be enhanced by responding to all sewer system blockages and spillage as a matter of urgency and clearing illegal dumpsites.
“The increase in uncollected urban waste is a matter of concern to many communities, and a source of disease transmission,” cautioned Mr Rusike.
He added, while residents can and have contributed to one-off clean-up campaigns to help remove waste, this does not replace this core obligation of local authorities.
Water quality
Mr Rusike called for facilitation of health promotion programmes through community participation and involvement.
“Information dissemination on good health and hygiene practices using posters, fliers, pamphlets and various media platforms should be enhanced.
“There is need to strengthen water quality monitoring to ensure water supplies and municipal boreholes are free from coliforms E coli, salmonella, Vibro cholerae and other contaminants. This also forms a key part of the water sanitation and hygienic responsibilities,” he added. Mr Rusike said the threat and risk of cholera outbreaks exist for as long as the conditions for transmission persist.
“Therefore, CWGH, is still encouraging boiling of water at household level and treatment of water using treatment chemicals where possible.
“We appeal to the urban local authorities to collect garbage regularly, and to treat water and sewage effectively. Communities should appreciate the importance of food and personal hygiene and especially promoting handwashing,” he noted.
Sustainable solutions needed
Mr Rusike also called for the strengthening of primary health care principles and laws regarding public health, which explicitly state that communities have a big role to play in public health, but they need an enabling environment for them to do so effectively.
Cholera vaccine
He encouraged communities to visit their nearest health facilities for any diarrhoeal illness for early treatment.
“Treatment of water at the point of use by boiling or using aquatabs remains important, looking at the continued failure by the urban local authorities to provide adequate safe water,” he said.
According to Mr Rusike, the cholera hot-spot areas and those struggling to deal with the cholera scourge should seriously consider introducing the cholera vaccine.
“But the vaccine should remain a complementary measure and not a replacement to the water sanitation and hygienic interventions, and these need to be implemented even as the population receives vaccination,” he emphasised.
Council’s headache
Harare City Council spokesperson Mr Innocent Ruwende said they were unable to collect refuse during the day — particularly at Copacabana, Market Square, Charge Office, Simon Muzenda (Fourth Street) and Rezende Parkade termini — as the areas will be inaccessible.
“They will be chocked up with buses and commuter omnibuses. This has led us to clear these bus terminuses during the night when accessibility is better.
“However, our efforts are being hampered by private players who are collecting refuse from residential areas and dumping it at these points to avoid paying fees at Pomona,” Mr Ruwende said in an interview.
He said shop owners or their tenants also added to the dilemma by using street kids to offload waste at the dumping points. “Shop owners are not permitted to dump waste in the skip bins. They should have the requisite number of bins so that when we come, we collect. We religiously deploy refuse compactors daily into the CBD and shop owners are expected to use these,” he said,
He added that the new phenomenon has caused “a serious environmental nuisance” at the bus termini, particularly in the CBD.
“The city will rigorously escalate its efforts to enforce the Harare anti-litter By-law Number 30 of 2016.
“Private players and shop owners who are caught on the wrong side of the law risk having their trucks confiscated and will pay heavy penalties. Shop owners risk losing their business licences,” warned Mr Ruwende.
Community engagement
According to the Cholera Risk Communications and Community Engagement (RCCE) brief #1 produced by United Nations Children’s Fund Zimbabwe, more than half of respondents interviewed expressed high cholera risk perception and were aware of the dangers of cholera but less knowledgeable about safe food practices to prevent cholera.
The RCCE said 61 percent of community rapid assessment respondents (adults between 18 and 60 years) were aware of a cholera outbreak within their community. Top two cholera prevention measures cited by U-reporters (15-23 years) were: washing hands with soap and water after toilet use (82 percent) and drinking treated water (15 percent).
Among the community rapid assessment respondents, top three cholera prevention measures were boiling/treating water for drinking (79 percent), washing hands with soap and clean water (63 percent) and washing fruits and vegetables with clean water (42 percent).
Africa’s challenge
Cholera has not only stalked Zimbabwe but several other countries.
In 2023 alone, Africa has recorded cholera cases in Cameroon, Ethiopia, Kenya, Burundi, the Democratic Republic of Congo, Malawi, Mozambique, Nigeria, Somalia, South Africa, Zambia and Zimbabwe.
According to the Centres for Disease Control and Prevention, an estimated 1.3 million to 4 million people around the world get cholera each year and 21,000 to 143,000 people die from it
Twitter: @RoselyneSachiti
